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Polytrauma
 

Polytrauma

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polytrauma management

polytrauma management

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    Polytrauma Polytrauma Presentation Transcript

    • Management of polytrauma patients at POF Hospital Dr.Monsif Iqbal PGT SU-II
    • Summary Case Presentation• Miss XYZ,a young lady 0f 23• RTA blunt trauma abdomen• Patient received in A & E• Patient then shifted to ITC
    • Primary Survey Case presentation • Pulse….122 • BP……..80/55 • GCS……15/15 • Irritable • pallor • Cold & Clammy • Grade 3 shock
    • FAST Case Presentation FAST performedFrank blood Shatteredin abdominal Spleencavity
    • Management ResuscitationExploratory Laparotomy
    • Resuscitation Case Presentation• I/V cannulae• Blood grouping & cross match• Restoration of intra vascularvolume• catheterization• antibiotic• Blood transfusion
    • Cont. Case Presentation Patient rushed to OT collapsed on OT table Successful CPR done blood transfusion Patient reverted back
    • managementEXPLORATORYLAPAROTOMY
    • Findings of exploratory laparotomy Case Presentation• Splenic injury ….grade 5• Renal injury…….grade 4• Lt colon crushed• Abdominal cavity full ofblood• Retroperitonealhematoma
    • Definitive surgical treatmentFindings of exploratory laparotomy Case Presentation• Splenetomy• Nephrectomy Lt• Sigmoid Colostomy
    • Post op recovery management • Mechanicl vent for 2 days • Drain output gradually reduced • Pneumovac given • Patient went into DIC with deranged PT & APTT • FFPs and platelets transfused • 7 blood transfusions done gradually • Stoma started working on 2nd POD
    • Cont….. management• Patient gradually reovered• Urine output remained satistory• Wound….healthy• Stitches out on 11th POD• Patient discharged home on 13th POD
    • DiagnosisManagement of polytrauma patients Resuscitation & definitive management
    • Componenets ATLS • Primary survey • Resuscitation • Secondary survey • Definitive management
    • Primary survey ATLS• A..airway & cervical spine care• B…Breathing & ventilation• C…circulation & hemorrhage control• D…Deformity & disability• E…exposure & environmental cond
    • Adjuncts to primary survey ATLS • ECG • Urinary & Gastric catheters • ABGs • Pulse oximetry • X-rays & Diagnostic studies
    • Secondary survey ATLS• History • Examination Blunt ?  Head & neck Penetrating ?  Chest Burn or cold  Abdomen injuries  Extremities  spine
    • Adjuncts to secondary survey ATLS• Detailed X-rays• CT scan• Angiography• USG• Transportation
    • Abdominal trauma
    • Blunt Abdominal trauma
    • Penetrating Abdominal trauma
    • Laparotomy
    • Focused Assessment with Sonography in Trauma FAST• FAST examines four areas for free fluid: – Morrison’s Pouch – Perisplenic – Pelvis – +/-Pericardium
    • Morrison’s pouch
    • How good is FAST? FAST• As a decision making tool for identifying the need for laparotomy in hypotensive patients (Systolic BP < 90), FAST has:• a sensitivity of 92%,• specificity of 96%• Accuracy 93%• How good is FAST?
    • DPL
    • Specific injuries Polytrauma• Spleen• Kidney• Liver• Intestine• Diaphragm• Pancreas
    • Spleen
    • Liver
    • Liver injuries management• Push• Plug• Pack• pringle
    • Kidney
    • Gradesof renal injury
    • Pancreas
    • Intestine
    • Damage control surgery
    • Colon
    • Diaphragmatic injury
    • Statistics of trauma in POF HOspital from jan 2010- jan2011
    • statistics polytrauma• Head injury….212• Blunt abdominal injury….67• Penetrating abdominal injury….17• Thoracic injury……27• Orthopedic inj…..89• Polytrauma …..56• Mortality…..24
    • ortho
    • Managementof Abdominal trauma Blunt abdominal traumaConservative Operativemanagement management 33 34
    • FAST done…. polytrauma• Total…..57• Positive……30• Inconclusive…..11• Negative……16
    • Head injury
    • Mortality
    • Take home message‘Multidisciplinary approach requiredfor management of polytraumapatient involving generalsurgeon,urlogist,orthpedicsurgeon,anesthetist,radiologist etc’